Objective To review our experience in treatment of liver hydatid diease.Methods The data of 819 patients who underwent surgery for hepatic hydatid disease were reviewed retrospectively.Exploration of common bile duct was done in 172 cases.There were men 95 and women 77with a mean age of 31.5±0.5 years.In addition to treatment of the cyst cavity,patients was divided into two groups.The patients in group A received cholangiography and exploration of common bile duct through cystic duct while those in group B underwent cholangiography and common bile duct ex-pioration through T tube.Results The length of hospital stay and cavity-related problems for both groups had no significant difference.Biliary tract-related problems in two groups had significant differ-ence.Conclusion Cholangiography and common bile duct exploration through cystic duct can com-pletely solve the cavity-related problems while avoiding T-tube related problems.

Objective To evaluate the clinical pathway (CP) for treatment of hepatic cystic echinococcosis.Methods Data were retrospectively obtained from hospitalized patients with hepatic cystic echinococcosis (CE) who were treated surgically between April 2011 to December 2012.Patient treated with the clinical pathway (the CP group) were compared with patients who were treated with conventional treatment (the non-CP group).The following outcomes were compared:the average length of in-hospital stay,the hospital charges,patient's satisfaction,patient's knowledge about his/ her own health and postoperative complications.Results For the CP groups,the length of in-hospital stay,the hospital charges,the patient's satisfaction and the health knowledge for the patients were (10.25±1.26)d,(19600.25±1520.73) yuan,(46.4 5±2.14),(83.50±8.02),respectively.The corresponding figures for the non-CP group were (14.25 ± 1.50) d,(23931.25 ± 1629.17) yuan,(42.65 ± 1.93),(74.50 ± 12.60),respectively.There were significant differences between the 2 groups (t=-4.086,-4.074,8.351,3.811 ; P＜0.05).The postoperative complications,including bile leakage,bleeding,ascites and pleural effusion,were 2,0,2 cases in the CP group,and 0,4,5 cases in the non-CP group.There were no significant difference between the 2 groups (x2 =0.17,0,0.6; P＞0.05).Conclusion Our initial clinical experience showed that the clinical pathway decreased the length of in-hospital stay and hospital charges,and provided quality and efficient clinical services to patients with hepatic cystic echinococcosis.

Objective To compare the efficacy of radical and quasi-radical hepatectomy for the treatment of end-stage hepatic alveolar echinococcosis(HAE)with involvement of major blood vessels and viscera.Methods The clinical data of 41 patients with end-stage HAE who were admitted to the First Affiliated Hospital of Xinjiang Medical University from January 2002 to January 2010.All patients were divided into radical hepatectomy group (13 patients)and quasi-radical hepatectomy group(28 patients)according to whether blood vessels were reconstructed and repaired.The operation time,blood loss,length of hospital stay,recurrence and metastasis of HAE,pleural effusion,ascites,biliary complications and death between the 2 groups were compared.All data were analyzed by using the t test or chi-square test.Results The volume of blood loss,length of hospital stay,number of patients with recurrence and metastasis of HAE,obstructive jaundice and number of dead patients were(326 ±115)ml,(22 ± 18)days,0,0,and 0 in the radical hepatectomy group,and were(24 ± 20)ml,(15 ± 12)days,10,10 and 10 in the quasi-radical hepatectomy group,there were significant differences between the 2 groups(t =13.41,1.47;x2 = 4.36,4.36,4.36,P ＜ 0.05).The operation time,number of patients with pleural effusion and ascites,bile leakage,cholangitis and number of patients died perioperatively were(407 ± 146)minutes,4,0,1 and 1 in the radical hepatectomy group,and(263 ± 93)minutes,2,2,2 and 1 in the quasi-radical hepatectomy group,there were no significant differences between the 2 groups(t = 3.81;x2 = 2.30,0.04,0.34,0.04,P ＞ 0.05).Conclusions Radical hepatectomy should be the first choice when construction of infringed vessels can be achieved.Quasi-radical hepatectomy has lower operation risks for avoiding important vessels injury.

OBJECTIVETo retrospectivly compare the clinical efficacy of dynamic hip screw (DHS) with proximal femoral nail anti-rotation (PFNA) for the treatment of unstable intertrochanteric fractures in the elderly.

METHODSTotally 92 elderly patients with unstable intertrochanteric fractures were treated with DHS [including 27 males and 23 females with a mean age of (72.5 +/- 5.3) years old] and PFNA [including 22 males and 20 females with a mean age of (72.8 +/- 5.8) years old] from August 2008 to August 2012. The data of operation time,blood loss (obvious and hidden blood loss), bedridden time, down load time, postoperative complications and Harris hip function score were recorded and compared.

RESULTSBoth of two groups were followed-up for 10 to 18 months with an average of 13.5 months. PFNA was implanted with a significantly smaller incision and shorter clinical healing time, less blood loss,while hidden blood loss were more. Postoperative complications, therapeutic effects and Harris score in PFNA group were better than that of DHS group.

CONCLUSIONFor treatment of senile patients with unstable intertrochanteric fractures, PFNA was superior to DHS in reducing complication rates, recovering hip joint, while DHS could reduce perioperative blood loss in treating type II a, II b and III fracture.

Aged ; Aged, 80 and over ; Bone Nails ; Bone Screws ; Case-Control Studies ; Female ; Femur ; surgery ; Fracture Fixation, Internal ; instrumentation ; Hip Fractures ; surgery ; Humans ; Internal Fixators ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

Objective To compare the health related quality of life (HRQoL) of ileal conduit versus orthotopic ileal neobladder using the FACT-BL scale.Methods One hundred and thirty patients underwent radical cystectomy and urinary diversion for invasive bladder cancer from Jan 2006 to Dec 2010 at our hospital.According to different urinary diversions,patients were divided into ileal conduit (IC) and orthotopic ileal neobladder (NB).HRQoL was assessed using FACT-BL.The following scores calculated from the FACT-BL questionnaire and list:physical well-being ( PWB ),social/family well-being ( SWB ),emotional well-being(EWB),functional well-being( FWB),overall bladder-special subscale and total FACT-BL were included.A high FACT score indicated a high level of HRQoL.The medical records of each patient were then reviewed.Clinical parameters including age,sex,type of diversion and pathological status were recorded and analyzed.Results A total of 94 questionnaires were collected,of these patients 50 had an IC and 44 had an NB.Among the respondents,the age at surgery was significantly younger in NB group than IC group (P =0.014 ).While the percent of males,follow-up years and pathological stage T3 or greater revealed no significant difference.The NB group got significantly higher scores in PWB,SWB,EWB and FACT-BL than the IC group.Which indicated that the HRQoL was higher in patients following orthotopic ileal neobladder.Conclusions The HRQoL was better in patients who followed orthotopic ileal neobladder than those who followed ileal conduit.This may indicate that orthotopic ileal neobladder should be considered first when making a decision about which urinary diversion should be used.

Objective To evaluate the effectiveness and safety of radical versus conservative surgery for hydatid liver cysts.Methods The Pubmed, EMBASE, MEDLINE, Cochrane Library, Chinese Biomedicine Database, CNKI, Wan Fang Databases, VIP Databases, Chinese scientific and technical journals full-text database and Chinese Journal of full text database were searched for randomized clinical trials or none-randomized clinical trials from January 2000 to January 2015.A Meta-analysis was performed with RevMan5.1.Results 10 studies with 2 123 patients were included into the final analysis.Meta-analysis demonstrated that the radical group was significantly longer in operation time [weighted mean difference (WMD) =25.11;95％ CI: 16.18-34.05;P ＜ 0.05], was significantly shorter in the length of hospital stay (WMD =-3.94;95％CI:-7.57-0.32;P ＜0.05), was significantly lower in the incidence of bile leak (OR =0.19;95％ CI: 0.07-0.49;P ＜ 0.05), was significantly lower in the incidence of residual cavity infection (OR =0.08;95 ％ CI: 0.04-0.15;P ＜ 0.05), and in the incidence of local recurrence (OR =0.10;95 ％ CI: 0.05-0.18;P ＜ 0.05) when compared with the conservative surgery group.Conclusions For hydatid liver cysts, radical surgical procedures had significantly lower rates of complications and recurrence.Thus, they are better treatments for hepatic cystic echinococcosis.

Objective To explore the efficacy of various managements of indurative biliary fistula after HCE operation.Methods 31 patients who underwent surgery for indurative biliary fistula after HCE operation in Xinjiang Medical University were studied retrospectively.Cholangiography and common bile duct exploration through a T tube were done in 15 patients,cholangiography and decompression through a T tube which led to the orifice of the fistula of the cavity in 8 patients,hepatectomy in 4 patients,lobe resection + choledochojejunostomy in 2 patients,total pericystectomy in 1 patient,and cavity abscess debridement in 1 patient for severe infection of the abdominal cavity,followed by hemihepatectomy after half a year.Result On follow-up of 1-8 years,choledochojejunostomy had to be done in 1 patient for stricture of the bile duct after T tube drainage,hepatectomy in 1 patient for bile leakage after the cavity abscess debridement operation,and bile leakage in 1 patient after hepatectomy although with drainage the patient was cured.Conclusion The results suggested that hepatectomy and total pericystectomy completely solved the problems arising from indurative biliary fistula.However,these procedures are complicated,and have higher operative risks.Cholangiography and common bile duct exploration solved the cavity-related problems.For patients with severe calcified cavities which communicated with large hepatic ducts,cholangiography and decompression through a T tube put into the orifice of the fistula of the cavity solved the indurative biliary fistula efficaciously and safely.

OBJECTIVETo explore rest, cold compress and elevate (RICE) with rest, compress and elevate (RCE) without cold for the treatment of acute ankle sprain, in order to clear mid-term clinical effects.

METHODSEighty-nine patients with acute ankle sprains were collected from January 2013 to March 2014,including 30 males and 59 females aged from 18 to 60 years old with an average of 36 years old; the time from injury to hospital ranged from 3 to 24 h with an average of 9 h. All patients were divided into two groups according to visiting sequence. There were 45 patients in RICE group, and 45 patients in RCE groups. The main therapeutic effect index was evaluated by Karlsson scoring, and secondary therapeutic effect index was pain and satisfactory VAS scores. Safety index evaluated by adverse event.

RESULTSOn the 2nd weeks after injury, Karlsson score in RICE group was 44.66 ± 11.58, and 46.67 ± 8.52 in RCE group, while there was no statistical significance between two groups in Karlsson scores (P > 0.05). Karlsson score of two groups after treatment were higher than before treatment. There was no significantly meaning in pain and satisfactory VAS scores between two groups (P > 0.05). No adverse reaction were occurred between two groups.

CONCLUSIONCold compress did not receive much more final gains, and no evidence showed cold compress could affect recovery of joint function.

Acute Disease ; Adolescent ; Adult ; Ankle Injuries ; physiopathology ; therapy ; Case-Control Studies ; Cold Temperature ; Female ; Humans ; Male ; Middle Aged ; Sprains and Strains ; physiopathology ; therapy

Objective To investigate the evolution of surgical treatment and it's influence on prognosis in reptured liver cystic echinococcosis.Method Clinical data of 110 surgically treated cases of reptured liver cystic echinococcosis from January 1990 to December 2008 were retrospectively analysed,and these cases were divided into three groups by different surgical approach;Group A(22 cases):removal of internal capsule,with formaldehyde or hydrogen peroxide regional anthelminthic,with residual cavity side edge of lock stitching or greater omentum filling or drainage after residual cavity closure;Group B (65 cases):Removal of intemal capsule,with hypertonic saline regional anthelminthic,with external capsule extrahepatic partial resection,with residual cavity bile leakage sutured,and with residual cavity open drainage,Group C(23 cases):the total or subtotal external capsule stripping operation,with hypertonic saline regional anthelminthic and drainage.Result The rate of overall postoperative complications of residual cavity was 40.9%、16.9%、0.0%(P<0.05)respectively and the recurrence rate was 18.2%、4.6%、0.0%(P<0.05)respectively;drainage time needed was the longest in group A,and shortest in group C,whereas the operation time was the longest in group C and it costed higher blood loss.Intraabdominal implantation of the hydatid significantly decreased with hypertonic saline treatment.Conclusion Total or near total removal of the external capsule of the hydatic cyst and hypertonic saline treatment with postoperative external drainage is the therapy of choice for reptured liver cystic echinococcosis.

Objective To analyze the efficacy of different treatment methods for end-stage hepatic alveolar echinococcosis combined with obstructive jaundice.Methods A retrospective study was conducted on the diagnosis and treatment of 55 patients with end-stage hepatic alveolar echinococcosis combined with obstructive jaundice managed from January 2000 to January 2013 at the First Affiliated Hospital of Xinjiang Medical University.The patients were divided into two groups according to the treatment options:group A,the palliative surgery group (n =38,69.1％) using palliative resection and biliary decompression ; and group B,the interventional group (n =17,30.9％) using percutaneous transhepatic cholangial drainage (PTCD).We analyzd the general data,preoperative and postoperative liver function,operation time,blood loss,average hospital stay,duration of postoperative tube drainage of abscess cavity,degree of lesion with invasion into the first porta hepatis,progressive lesion,continuous invasion and/or distant metastasis,biliary complications,mortality,and cumulative survival rates.The t-test or t'-test was used to analyze continuous data and the chi-square test was used to analyze categorical data.Parallel log rank test and Kaplan-meier method were used to calculate survival rates in survival analysis.Results When compared with group B,group A had significantly longer operative time,more blood loss,and longer average hospital stay (P ＜0.05).The postoperative total bilirubin,direct bilirubin,γ-glutamyl transpeptidase and alkaline phosphatase,aspartate aminotransferase,alanine aminotransferase were significantly higher than in group B (P ＜0.05).The level of post operative albumin was lower in group A than in group B.The two groups of patients (A and B) had similar background including general data (gender,age,nation),preoperative liver function,duration of postoperative tube-drainage of abscess cavity,degree of lesion-invasion into first porta hepa tis,progressive lesion-invasion and/or distant metastasis,biliary complications,mortality,cumulative survival rates and survival curves.Conclusions Interventional treatment is an effective treatment for end-stage hepatic alveolar echinococcosis combined with obstructive jaundice.It has the advantages of minimal invasiveness,simplicity,safety and repeatability.It may replace traditional palliative surgery in the future.